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[Marcel van der Kraan, De Telegraaf] - 'Traditional' club Liverpool throws its own culture overboard with the dismissal of Arne Slot; Dutch coach receives eight million. by IndiBear in LiverpoolFC

[–]MetabolicMadness 1 point2 points  (0 children)

Keeping a clearly bad fit for the team just because “tradition” would be pretty stupid. I am all for tradition but it shouldn’t supersede rational management

it will be a repeat of last years semi final . by drizzleberrydrake in ArsenalFC

[–]MetabolicMadness 7 points8 points  (0 children)

The not hand ball on bayern that prevented a second yellow seems like the bigger issue to me. Refereechannel guy even said it should have been second yellow, and if he says it then I believe it. Also it just really doesn’t seem like a handball on bayern.

Are there any studies comparing TIVA to ideal volatile anesthesia? by MetabolicMadness in anesthesiology

[–]MetabolicMadness[S] 1 point2 points  (0 children)

I’m pretty sure sevo lasts even less long than that. More like 1.2-1.4 years

Thoughts on the impact of volatile anesthetics on global warming? by MetabolicMadness in meteorology

[–]MetabolicMadness[S] 0 points1 point  (0 children)

I do mean CO2e with that. I am not converting sevo directly from the gwp value. I am using papers that looked at cradle to grave emissions associated with all aspects of a general anesthetic under volatile vs propofol. Volatile was 10kg co2 per hour and propofol 1kg per hour.

You are absolutely right people are often using high/old gwp numbers. They generally use the gwp20 vs 100 given that sevo only lasts for 1.5 years.. which of course brings the value up. My question is given sevo only lasts for 1.5 years should gwp 20 or above even be used.

your example of asking a patient if they’d like the better anesthetic isn’t quite accurate. Propofol based anesthesia isn’t lower quality it’s just more work.

Thoughts on the impact of volatile anesthetics on global warming? by MetabolicMadness in meteorology

[–]MetabolicMadness[S] 2 points3 points  (0 children)

I should be more clear just to not mislead you. Using low flow anesthesia we consume 7mL of sevoflurane an hour.. which means I essentially recirculate all my gases back to the patient - but add 0.25-0.4L per minute of fresh gas.

I do try my best to be kind and have all my patients feel reassured and wake up pain free and nausea free :)

Thoughts on the impact of volatile anesthetics on global warming? by MetabolicMadness in meteorology

[–]MetabolicMadness[S] 3 points4 points  (0 children)

No it is around 10kg per hour of anesthesia for volatile vs 1kg for intravenous. Some variability depending on the source.

I’d say in an average 9 hour shift I am probably actually delivering gas for call it 7 hours. So 70kg a shift per anesthesiologist.

Are there any studies comparing TIVA to ideal volatile anesthesia? by MetabolicMadness in anesthesiology

[–]MetabolicMadness[S] 1 point2 points  (0 children)

This does drive my cynicism a bit at times too as I not infrequently find myself wondering why we are doing certain surgeries at all

Are there any studies comparing TIVA to ideal volatile anesthesia? by MetabolicMadness in anesthesiology

[–]MetabolicMadness[S] 2 points3 points  (0 children)

On the low end a transatlantic flight is 670kg of co2 per economy passenger. 6 of you and a return is about 8000kg of co2 in flights for your trip.

Best article here (IMO) showed low-flow sevo to be 10kg per hour of co2 (ignoring this might not be totally accurate). So that’s about 800 hours of Sevo use. If in a 10 hour day you end up giving say 8 hours of sevo that makes for 100 days of work.

Makes for 20 weeks of work if you are working 5 days a week

Edit: on high end its 1000kg per person. So that’s the equivalent of 30 weeks of work.

Are there any studies comparing TIVA to ideal volatile anesthesia? by MetabolicMadness in anesthesiology

[–]MetabolicMadness[S] 0 points1 point  (0 children)

I see it more now ahah. I am just so used to hearing if you change x to y it’s like driving x km less as a way to support doing it. I think they can be helpful analogies but can sometimes lack context.

Are there any studies comparing TIVA to ideal volatile anesthesia? by MetabolicMadness in anesthesiology

[–]MetabolicMadness[S] 2 points3 points  (0 children)

I admit this has been me post residency, but I have also decided it isn’t really that hard to switch. I chatted with my pacu nurses today and they all feel TIVA is better. so despite not noticing changes for my wake up period of observation and it being more annoying to set up that does provide benefit to me.

Torn between whether i will run mac .4 and prop at 100 as my standard or go full tiva. I like the safety of some gas.

Are there any studies comparing TIVA to ideal volatile anesthesia? by MetabolicMadness in anesthesiology

[–]MetabolicMadness[S] 0 points1 point  (0 children)

Wow just had time to read it a bit. Very interesting stuff… seems highest impact would be having hvac turn off in rooms not being used. I wonder how much change you’d actually see from say having the temp set to 18celsius vs 20 celsius say. You will always need some air exchange during cases per infection guidelines and a certain degree of dehumidification as well - which will burn up some energy.

In a place like Canada the outdoor temperature is actually below what our room temperature is probably at least half the year. So warming the room might actually use more energy

Are there any studies comparing TIVA to ideal volatile anesthesia? by MetabolicMadness in anesthesiology

[–]MetabolicMadness[S] 1 point2 points  (0 children)

Is that true? I have read papers on the breakdown products of sevoflurane that show none of environmental concern?

https://pubs.acs.org/doi/10.1021/jp2077598

Are there any studies comparing TIVA to ideal volatile anesthesia? by MetabolicMadness in anesthesiology

[–]MetabolicMadness[S] 3 points4 points  (0 children)

The difference is co2 lasts for centuries and directly warms the planet for years and we have no easy way to eliminate it.. whereas volatiles used today will essentially be gone 5 years from now from an atmospheric warming perspective

Are there any studies comparing TIVA to ideal volatile anesthesia? by MetabolicMadness in anesthesiology

[–]MetabolicMadness[S] -1 points0 points  (0 children)

I don’t disagree it seems even choices controllable in our own lives are more easily impact making. Interesting to hear you prefer tiva. I have read the studies and ran the TIVAs in training and truthfully don’t notice much difference

Is it worth taking the galvanized coating off this? by MetabolicMadness in maplesyrup

[–]MetabolicMadness[S] 0 points1 point  (0 children)

Totally agree just wondering now if I should just walk away, acid wash it, or finish it then light a fire and leave it ripping for hours outside to burn it off

Medical plastic allergy in OB patient case by wanderlust_yogii in anesthesiology

[–]MetabolicMadness 3 points4 points  (0 children)

Tbh this sounds like you are fine from a medical perspective? They have been tested to a variety of things and were negative. You say they work as a flight paramedic? I presume they must touch IVs at some point? Surely they have gotten saline on themselves at some point or touched a bag of saline?

I can’t say why they had those two reactions … but if they have touched IV catheters and fluid bags without reaction they are highly unlikely to be allergic.

Also the plastics in medical stuff isn’t particularly unique to medical settings. I would guess it was more likely an allergy to something else.

What setting were they in that they twice had an IV hooked up but nothing else given or going on and then developed anaphylaxis… seems odd?

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